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‘Unethical and harmful’: the case against circumcising baby boys

For centuries, children have been subjected to cultural and medicalised practices that were ultimately proven harmful and a violation of basic bodily integrity. Such practices have included foot binding…

The foreskin is the most sensitive part of the penis. Flickr/NoVa Hokie

For centuries, children have been subjected to cultural and medicalised practices that were ultimately proven harmful and a violation of basic bodily integrity. Such practices have included foot binding, forehead flattening, scarification and genital cutting.

In English-speaking countries, the practice of cutting the genitals of male children was gradually medicalised over a period of 150 years with the benign-sounding label “circumcision.”

Today, there is increasing awareness that infant male circumcision – once deemed a “parental choice” – is really an unnecessary, irreversible and harmful bodily modification.

With the recently discovered functions of the foreskin and a growth in awareness, we’re fortunately beginning to see the rights and experience of the child become the paramount consideration in discussions about circumcision.

The foreskin

The human foreskin is a contiguous part of the skin system of the clitoris or penis.

In infant males, the foreskin is attached to the head of the penis (glans). The outer foreskin protects the more sensitive inner foreskin and the glans from abrasion and injury.

The moveable skin facilitates sexual pleasure. In fact, the foreskin is typically the most sensitive area of the penis.

When circumcised males lose sensitivity and skin mobility, it’s likely to significantly alter their sexual experience.

One recent Danish cross-sectional study concluded that male circumcision was associated with sexual difficulties for men and their female partners.

Bioethics of a non-treatment surgery on minors

Surgery without consent is ethical only in cases for:

1) incapacitated patients, in order to save their life

2) minors, with proxy consent from a parent or guardian, but only for surgery that addresses an underlying condition.

Excision of an infant’s foreskin for dubious medical or cultural purposes is an anomaly. Because it removes healthy, typically-developed tissue, the procedure fails to meet either of the above conditions.

Circumcision of minors also stands in contradiction to other medical ethics principles, including:

  • Avoiding causing needless harm

  • Promoting the patient’s medical well-being

  • Providing information on a procedure that a reasonable person would deem significant.

Complications

Circumcision can cause skin bridges, haemorrhaging, infection, as well as major penile damage.

Dozens of case studies describe severe complications, including penile amputations and death; several infant deaths have been reported in the past few years.

A Canadian Coroner’s report, issued in 2007 following the death of a baby in Ontario, recommended the Canadian Paediatric Society conduct a surveillance study on complications.

The most detailed assessment of circumcision complications cites meatitis (affecting 8% to 31% of those circumcised), infection (affecting between 0.4% and 10%, age varying) and many other severe complications.

A more recent British literature survey estimates complications, including infection and hemorrhage, at rates as high as 10%.

Paediatric urologist David M. Gibbons, commented on MensHealth.com: “in a two year period, I was referred [more than] 275 newborns and toddlers with complications of neonatal circumcision … 45% required corrective surgery (minor as well as major, especially for amputative injury) …”

Another urologist reported repairing over 1,600 botched circumcisions over a three-year period.

Official rates of complications are likely to be under reported. But regardless of the actual complication rate, it is unethical to subject a child to these risks.

Insignificant benefits

While some use medical benefits to justify male circumcision, those gains rarely materialise in the real world, and the damage outweighs any gain.

For example, circumcision is purported to reduce female-to-male HIV transmission by 50% to 60%. But studies of the general population have failed to find any decrease in HIV infection rates among circumcised men compared with uncircumcised men.

HIV rates are three to four times higher in American men (mostly circumcised) than in Europe (rarely circumcised). But factors far more significant than circumcision status determine HIV transmission.

While proponents claim circumcision reduces other sexually-transmitted infections (STIs), a 2008 New Zealand birth cohort study did not find any such evidence.

Misleading portrayal

Despite potentially severe complications, hospital websites generally portray circumcision as values-neutral and safe.

Because most hospitals don’t give parents adequate information on the risks of circumcision to allow for true informed consent, few parents understand the effects their choice will have on their child and the adult he will become.

Parental regret and survivor perspectives

In blogs, vlogs and other online forums, many parents have shared concerns about their child’s circumcision.

Experiences range from “If I knew what I know now, I wouldn’t have done it,” to “I will die hearing my baby’s screams”.

Many men have also expressed dissatisfaction with their circumcision, including a sense of “being violated,” “being sexually maimed,” and having feelings of anger toward parents or the medico who performed their circumcision.

On thousands of websites, Facebook groups and blogs, circumcised men go to share their experiences and support one another.

Society’s role

A cultural framework that considers circumcision ethically neutral and the foreskin “a useless flap of skin” omits important considerations.

Before debating supposed benefits, we need to ask why would we ever even consider cutting our children’s genitals.

The medical benefits of male circumcision are insignificant: no evidence to date justifies irreversible surgery on children unable to give consent.

Society has recognised the inherent right of minor females to be free from unnecessary genital cutting.

In the twenty-first century it is time to recognise the same rights of male children.


Is infant male circumcision unethical and harmful? Have your say below.

Read Brian Morris' article Male infant circumcision: ‘safe, convenient, cheap and fast’


For more of Ryan McAllister’s research in infant male circumcision, watch his recent university lecture: Circumcision, an Elephant in the Hospital.

Watch John W. Travis' video on infant wellness and circumcision here.

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28 Comments sorted by

  1. Paul Richards
    Paul Richards is a Friend of The Conversation.

    Has your research into male circumcision disproved the geographical correlation between lower HIV prevalence and high rates of male circumcision in some countries in Africa?

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    1. Joseph Lewis

      logged in via Facebook

      In reply to Paul Richards

      Richard, according to demographic health surveys, HIV was found to be more prevalent in circumcised men in 6 different African countries.

      According to USAID, HIV was found to be more prevalent in circumcised men in 10 out of 18 countries.

      What about correlations across the globe? Aren't scientists going to explain why HIV is more prevalent among the circumcised in the US vs Europe?

      Studies show that the US has higher HIV transmission rates than Africa. 80% of US men are already circumcised, yet the proposition is "circumcise 80% of African men to reduce HIV."

      Can somebody explain why something that never worked in our own country is going to suddenly begin to work miracles in Africa?

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    2. Jake Waskett

      logged in via Facebook

      In reply to Joseph Lewis

      Observational studies aren't perfect, and sometimes they get the wrong results. They're susceptible to confounding factors that can mask underlying associations. So the fact that a minority of observational studies have found higher rates of HIV in circumcised men shouldn't be surprising.

      As has been explained many times in the past, the US has much lower levels of sex education and subsequent condom usage than Europe, so by comparing the two you're failing to isolate the effect of circumcision. It's a comparison between apples and antelopes.

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    3. Ryan McAllister

      Research Assistant Professor of Physics and Oncology at Georgetown University

      In reply to Paul Richards

      There exists no scientific consensus of benefits from circumcision.

      There is also not a geographic correlation between circumcision and HIV. For more information on the question of circumcision and HIV, I refer you to our publication in the American Journal of Preventive Medicine, a pdf of which I have posted here:

      http://physics.georgetown.edu/~rmca/Elephant_in_the_Hospital/Circumcision_and_HIV_Prevention_2010_Green_AJPM.pdf

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    4. Paul Richards
      Paul Richards is a Friend of The Conversation.

      In reply to Ryan McAllister

      Thank you Ryan,
      I now have a clearer understanding of this highly emotive issue.
      Some appropriate focus on - female circumcision - could be very beneficial.

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    5. Paul Richards
      Paul Richards is a Friend of The Conversation.

      In reply to Joseph Lewis

      It is hardly surprising that US have a higher incidence of HIV rates than Africa as they have an epidemic of unsafe IV use when taking drugs.

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    6. Hugh Young

      independent researcher

      In reply to Jake Waskett

      Jake didn't read Ryan's link, which includes Banerjee et al.'s rebuttal and Ryan et al.'s response. I don't know who Banerjee is, but his et al. is just about a roll-call of the pro-circumcision clique - lacking only Jake himself.

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    7. John Bastion

      logged in via Facebook

      In reply to Joseph Lewis

      I wonder if the African studies have controlled for religion - which likely is the primary reason men were getting circumcised in the first place. Their religious beliefs may change the number & nature of sexual partners they choose (eg. number of partners, and long term versus short term), and hence HIV prevalence. So yep.. a likely confounding factor in my opinion.

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  2. John Bastion

    logged in via Facebook

    Paul, good question :). Geographical correlations with circumcision would also mirror the dominant religions in those regions. Very very likely that the areas in which circumcision take place are Muslim (or perhaps Christian), and due to this they limit the number of sexual partners (particularly in the case of women).

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    1. Paul Richards
      Paul Richards is a Friend of The Conversation.

      In reply to John Bastion

      Yohans,
      I asked about relevancy because this is article is contrary to the WHO and UNAIDS
      announcement of recommendations from expert consultation on male circumcision for HIV prevention. In Paris - Geneva, on 28 March 2007 - In response to the urgent need to reduce the number of new HIV infections globally.

      With a direct reference to Dr Kevin De Cock,
      Director, HIV/AIDS Department, World Health Organisation.

      Yes, that is his name.

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    2. Hugh Young

      independent researcher

      In reply to Paul Richards

      The WHO recommends VOLUNTARY ADULT circumcision in regions of HIGH PREVALENCE. (Unsurprisingly, that aspect of the recommendation is being ignored.) No study has shown that neonatal circumcision has any effect on HIV transmission, nor that any circumcision has any effect on transmission between men, the commonest kind of sexual transmission in the developed world.

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  3. Bruce Baer Arnold

    Assistant Professor, School of Law at University of Canberra

    As the Tasmanian Law Reform Institute's discussion paper on non-therapeutic male circumcision (at http://www.law.utas.edu.au/reform/malecircumcision.htm ) acknowledges, circumcision is an integral part of belonging and identity in some Australian communities. From a human rights - and more broadly a legal - perspective it is important to look beyond epidemiological claims/counter-claims in recognising that Australia is pluralist rather than 'Anglo' and that in the absence of proven harms particular communities can quite validly choose to circumcise young males. A dismissal of the Jewish community on the basis of contested assertions is unwarranted

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    1. Hugh Young

      independent researcher

      In reply to Bruce Baer Arnold

      If "circumcision is "an integral part of belonging and identity in some Australian communities" then it is equally integral that circumcision be self-chosen. Human rights inhere in humans, not the communities they happen to have been born into. Harms, like benefits, can never be "proven" to universal satisfaction. Suffice it that person who has been circumcised thinks he has been harmed - if only be the loss of his right to choose for himself what parts of his own genitals he wants to keep.

      The…

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    2. Ryan McAllister

      Research Assistant Professor of Physics and Oncology at Georgetown University

      In reply to Bruce Baer Arnold

      While there exists no scientific consensus of any benefit from circumcision, it is clear that it exposes children to risks and harm without the intention to treat. Therefore we argue that it does not meet the ethical criteria for surgeries performed on minors.

      It is an in-community discussion for those of faiths and cultural practices to consider this argument.

      It is not our position to dismiss those communities nor to underestimate their ability to handle the discussion of challenging topics.

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    3. Jake Waskett

      logged in via Facebook

      In reply to Ryan McAllister

      That's not a terribly logical position to take, though. The only sense in which there "exists no scientific consensus of any benefit" is that it's disputed by a tiny number of anti-circumcision activists, of which you are one. The vast majority of scientists agree that circumcision has benefits.

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    4. Ryan McAllister

      Research Assistant Professor of Physics and Oncology at Georgetown University

      In reply to Jake Waskett

      It is my experience of the scientific community that we have no consensus about any benefits of circumcision, and that many of us have strong concerns about the procedure.

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  4. Michel Hervé Navoiseau-Bertaux

    logged in via Facebook

    "in the absence of proven harms particular communities can quite validly choose to circumcise young males"

    Your "law" is the law of the strongests (adults), Mr Arnold.

    Our law is the following: look it up for your next lectures:

    - Universal declaration of the rights of the child of the United Nations organization (20 November 1959):

    "Principle 9: The child shall be protected against all form of... cruelty and exploitation..."

    "Principle 10: The child shall be protected from practices that… may foster racial, religious or any other form of discrimination..."

    - International convention on the rights of the child of the United Nations organization (20 November 1989):

    "Article 14 – 1: States Parties shall respect the right of the child to freedom... of religion."

    "Article 19: States parties shall take all appropriate legislative, administrative, social and educational measures to protect the child against all forms of physical or mental violence..."

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  5. Michel Hervé Navoiseau-Bertaux

    logged in via Facebook

    Of course, that was from a purely "human rights - and more broadly a legal - perspective"!

    Now, there is a particular article in French law that you could also meditate:

    Article 225-14 of the French penal code:

    "The subjection of a person whose vulnerability or state of dependence is apparent or known to the author, to working or living conditions incompatible with human dignity is punished by five years in jail and a 150 000 Euros fine."

    and article 225-15 states:

    "Offences defined at... article 225-14..., when committed towards a minor... are punished by seven years in jail and a 200 000 Euros fine."

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  6. Michel Hervé Navoiseau-Bertaux

    logged in via Facebook

    I also need to say that when Mr Paul Mason was the high comissioner of children for Tasmania, which is not very long ago, your speech would not have been admitted.

    It seems Australia is returning to the Stone Age!

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  7. John Q

    Software developer

    The evidence for lifelong health benefits of circumcision starting at birth is overwhelming.
    Controlled studies show there is no difference in sexual satisfaction.
    I was circumcised as an adult and only wish it had been done at birth.

    Parents make important decisions for their children all the time.
    The health benefits of circumcision far out weigh the risks.
    Parents have the right to offer those benefits to their sons.

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    1. Ryan McAllister

      Research Assistant Professor of Physics and Oncology at Georgetown University

      In reply to John Q

      That you are happy you were circumcised is not a reason to perform an elective surgery upon children.

      Many survey studies show a difference in sexual satisfaction. And, as noted above, in a large body of blogs and vlogs men report not wanting to have been circumcised. Hence our position that this decision should be left to the person upon whom it was performed.

      In the response letters to our article on HIV and circumcision, we cite additional studies about circumcision and sexual dissatisfaction. Those interested can find the whole series here:

      http://physics.georgetown.edu/~rmca/Elephant_in_the_Hospital/Circumcision_and_HIV_Prevention_2010_Green_AJPM.pdf

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    2. Hugh Young

      independent researcher

      In reply to John Q

      "The evidence for lifelong health benefits of circumcision starting at birth is overwhelming. ...The health benefits of circumcision far out weigh the risks."

      Risk/benefit analyses of circumcision come down against it.

      "Controlled studies show there is no difference in sexual satisfaction"
      There have been no double-blinded, controlled trials of circumcision's effect on sexual satisfaction, and the trials in Uganda had an agenda that was clear to everyone who took part. They were all before-and-after…

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    3. Judy Chapman

      Midwife

      In reply to John Q

      I also see this attitude in midwifery. If a person is happy with whatever interevention they had for what ever reason, then everybody else must be happy with it.
      As a mother I would certainly look at the morbidity or mortality (baby boys do die from routine non necessary circumcision ) rates and compare it with the dubious benefits and then vote for non intervention.
      I am very glad, and so is my adult son, that he is intact.

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  8. John Smith

    writer

    Circumcision is mutilation pure and simple and should not be allowed.

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  9. Tora Spigner

    logged in via Facebook

    Circumcision of minor children exists because these babies can't say no, plain and simple. I am sure that if all baby boys were left intact, as nature made them, they could chose for themselves if they wanted to be circumcsed as adults, if they felt it important to THEIR religious choices or own beliefs. Since 1% of adults choose circumcision for themselves, it would be a totally acceptable option for someone and they can have adequate analgesia and anesthesia. We do not have the right as parents to cut our baby girls, so baby boys should have the same rights to genital integrity. As more and more parent's decide they are not the owner of their children's genitals, less and less cutting is done in this country. That is a positive movement and one I encourage and support. His body, His Choice!

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  10. Robert Samson

    logged in via email @verizon.net

    The most crucial scientific test for validity of an hypothesis is its ability to ALWAYS fulfill its prediction, and the circumcision/HIV hypothesis fails miserably to meet this requirement.

    The nebulous excuses of Jake Waskett of co-founders in the real world causing this failure to fulfill will not rescue this hypothesis.

    What is required to account for this discrepancy between prediction and reality is proven and definitive co-founders with solid numbers within a model. So far no one has offered this evidence, and hence the hypothesis in invalid.

    As for any other alleged "benefit", I challenge anyone to provide a single PROVEN benefit that is actually seen in the real world empirical evidence.

    Until and if one can offer one (or more) that outweigh the PROVEN risks and harm, this procedure cannot be justified.

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